Everybody knows somebody who has had a problem with their Achilles Tendon (AT). This structure is one of the most injured in runners and this injury is seen very often in the more recreational athlete.
Achilles Tendinopathy Types
It is important to understand that there are 2 major types of Achilles Tendinopathy.
Mid-Portion:
This is the more common form of Achilles Tendinopathy
It affects the tendon about 2.5-3cm above where the tendon attaches on the heel.
Achilles Tendinopathy is generally caused by a sudden increase/change in load (due to spikes in activity or changes in footwear) on the tendon.
Insertional:
This is less common form of Achilles Tendinopathy however is generally much more painful.
This is felt on the back of the heel bone itself, where the Achilles attaches.
It is generally caused by a compression (squashing) of the tendon against the heel bone as the foot is brought back towards the shin (dorsiflexion).
Insertional Tendinopathy is much harder to “cure” and I would strongly encourage you seek professional advice if you have this problem. In this situation, it isn’t unusual to be a contributing systemic condition, such as Rheumatoid Arthritis and can result in calcification of the tendon, which is essentially the tendon turning to bone.
In a nutshell, management of Achilles Tendinopathy is about two things.
Pain management
Load management.
It is important to understand that, as a rule, the Achilles Tendon only begins to hurt when the demands placed on it are greater than its capacity to perform said demands. This is why the Achilles Tendon doesn’t hurt when you don’t do anything.
Achilles Tendinopathy Management tips :
Don’t Rest
Yes, you heard us correctly. Rest is the worst thing for any tendon problem. If you don’t load a tendon its capacity will diminish (it becomes weaker) making it easier to aggravate when you need to use it. Rather than resting, you should look to modify your activity. I am a big fan of simple strength work in the early stages of Achilles Tendinopathy to build capacity.
Isometric calf raises (this is when you hold a contraction rather than moving the muscle backward and forward) are a fantastic way of building strength and reducing pain in a symptomatic Achilles Tendon. Any quality healthcare professional will help you devise a suitable program.
Footwear/Heel Lift
Change to a shoe that has a higher stack/drop or place a heel lift inside your shoes. For women and some men, this means the use of high heel shoes can be beneficial in managing Achilles Tendinopathy (even if they may cause other issues if used for too long). The greater the fall/drop from the back of the shoe to the front, the less eccentric load (lengthening load) is placed on the Achilles Tendon. Reducing this load on the tendon will reduce pain levels.
Training Environment
Get off hard ground and playing surfaces and avoid inclines if at all possible. There have also been studies that indicate that treadmill running increases the load on the calves and Achilles when compared to running on the road. These aggravat Achilles problems.
Running Technique/Training Intensity
If you are a forefoot/midfoot striker or do a lot of high-intensity workouts, it may be worth looking to change to a heel strike pattern, go for longer runs or move to low-intensity workouts to reduce the load on the Achilles Tendon until you build capacity.
Seek Professional Help
If managed early, Achilles Tendinopathy can be resolved reasonably quickly. If left, however, it can become a chronic problem which may take months to resolve. A quality healthcare professional will guide you through the rehab process and get you back doing what you love, fast!
